Homeopathic Materia Medica by Farrington

SEPIA, PART II

()

Let us resume our study of Sepia. Going still lower in the abdomen, we find it exhibiting a very marked action on the uterine organs, causing, as I mentioned the other day, engorgement of the uterus with displacement. In a well-advanced Sepia case the uterus is enlarged and the cervix is indurated. The organ is either prolapsed or retroverted. Leucorrhoea is a very prominent symptom, the discharge being of a yellowish-green color and somewhat offensive. With these objective symptoms we find bearing-down pains in the abdomen and in the small of the back. This is so extensive at times that it seems to interfere with breathing. Sometimes the patient feels as if everything would be forced out through the vulva. This feeling seems to be relieved by sitting with the limbs crossed. With the bearing down there is associated a backache, referable to the lumbar or sacral region. It is decidedly worse when the patient is standing or walking. There are burning pains in the uterus, and sometimes pains of a sharp character shooting upwards, or there may be a sensation as if the uterus was clutched by a hand (CACTUS and LILIUM have this symptom also) The menses are usually late and scanty, although exceptionally they may be early and profuse.

The most similar remedy to Sepia is LILIUMTIGRINURN, for the provings of which we are indebted to Dr. William Payne, of Bath, Maine. He was led to make the provings after learning that the flowers of this plant had caused convulsions in a child. He thought that it might prove to be a valuable remedy in the convulsions of children. In his provings he was assisted by Dr. Dunham and a number of ladies. He observed convulsions in the course of the provings, but in almost every instance there was some alteration in the functions of the uterus and ovaries noticed. Lilium tigrinurn uterine symptoms are those which often follow pregnancy and labor. It is indicated in cases of subinvolution and labor. The uterus does not regain its normal size after confinement. When the patient rises to walk, the uterus falls by its own weight. The patient complains of heavy, dragging sensation, principally in the hypogastric region. She feels the need of some support to hold the abdominal organs up. This is very similar to Sepia. In Sepia the woman sits with her legs crossed, thus giving an artificial support to the uterus. The leucorrhoea, too, is quite similar. Under Sepia it is yellowish-green, somewhat fetid, and often excoriating. Under Lilium I think the most characteristic leucorrhoea is watery, yellowish, or yellowish-brown, and excoriating. This excoriating property of Lilium is quite characteristic. The provers of Lilium had in two cases prolapsus, and in one, retroversion of the uterus. There is urging to urinate under Lilium; the urine when it passes causes burning and smarting, the same kind of feeling at the meatus urinarius as the leucorrhoea causes at the vulva. Then, too, you will find urging to stool; morning diarrhoea, hurrying the patient out of bed, the stool being yellow, papescent, and causing an excoriating feeling at the anus. Here Lilium rubs against Sulphur, which has characteristically early morning diarrhoea. The Lilium symptoms are usually worse in the afternoon, while those of Sepia have remission at that time of the day.

Lilium has some chest symptoms which are worthy of note. Patients experience a full, crowded feeling in the chest, as though there were too much blood there; they want the windows open, as fresh air gives them relief. This oppression of the chest is caused by venous stasis. With this feeling of oppression there is a taste as of blood in the mouth, reminding one of Pulsatilla and Hamamelis, both of which have that symptom. There is a feeling as of a rivet or a bullet in the mammary region ; also a feeling of coldness about the heart. Natrum mur. cures this last symptom when it appears during mental exertion; Lilium, when it occurs as a result of uterine disease. Dr. Richard Hughes reports a case with that symptom which he cured with Petroleum.

HELONIAS according to Dunham, "produces profound melancholy, deep, undefined depression, with sensation of soreness and weight in the womb, 'a consciousness of a womb.' Lilium dulls the intellect, produces a sensation of hurry, with inability, and distress based on an apprehension of having some fatal or serious malady." And, further, Helonias is an excellent remedy when there is a tired, aching feeling, and some burning in the back and legs. This is common enough with women, and no remedy, unless it is PICRICACID, relieves more promptly. The debility of Helonias is the result of impaired nutrition. Experiments have clearly demonstrated the fact that there results from its use a diminution of red corpuscles, and a general impoverishment of the blood.

SULPHUR is often needed to aid Sepia in a chronic case. The complementary relation lies in the common power of the two drugs to correct abdominal congestion and other vascular irregularities. Sometimes, when the latter is in use, a forenoon "goneness" becomes marked as an eleven o'clock faint, hungry feeling. Or, flushes of heat persist. Again, a one-sided headache persistently returns and weakens the patient. Piles grow worse. The bearing down becomes continuous, with a weak feeling in the genitals. Then Sulphur is substituted, and improvement is at once noticed. After a while, however, the symptoms shift pointedly Sepia-ward; and so the two alternate. Several such cases have been observed. One patient from the West was entirely cured with these two drugs, and remains well. She had been an invalid for years.

MUREX, a mollusc, bears a family resemblance to Sepia. Provings are, as yet, meagre. But clinical experience has confirmed some of the symptoms. Dr. Dunham, and after him, Dr. B. F. Betts, have made comparisons between Murex and Sepia which are sufficient guides in their differentiation.

It differs, however, in that it causes sexual excitement; " desire so violent as to fatigue the reason;" "venereal desire renewed by the slightest touch."

Secretions are more copious than is usual with Sepia. Thus menses are profuse instead of scanty. Copious urination at night; urine pale; wakes with a start, and a violent desire to urinate. This is not so marked in Sepia. Both, however, have intermittent menses.

Both remedies are useful in the affections of the cervix: Murex when there is a sensation of soreness, or "a feeling as though something was pressing on a sore spot in the pelvis"—(Betts). Lancinating pains upwards to abdomen or thorax; thick, green or bloody leucorrhoea. Murex agrees rather with Lilium and PLATINA in sexual erethism, and with KREOSOTE in urinary symptoms.

Clinically it has been used for polyuria, with frequent urging at night. KREOSOTE has: Sudden urging, cannot get out of bed quick enough; urinates with great haste, and passes a large amount; urine offensive.

Kreosote, moreover, bears some relation to Sepia. Both have intermittent menstrual flow, dragging downwards in the back, and pressure outward in the genitals; painful coitus; vomiting of pregnancy; urine deposits a red sediment, and is turbid and offensive.

But the menses are usually copious. They are accompanied with somewhat different reflex symptoms from those belonging to Sepia; notably, difficult hearing, with humming and roaring in the head. The dragging in the back is relieved by motion, not aggravated as in Sepia, and the leucorrhoea is more irritating, acrid; it excoriates the parts over which it flows. Sometimes it is yellow, when it has the odor of fresh green corn.

This acridity of leucorrhoea marks clearly the divergence of Kreosote from Sepia, as well as from Murex. This led to the employment of the drug in cancerous and other ulcerations of the cervix uteri. And we now choose it when there are burning, sensitiveness, and tumefaction of the cervix, with bloody ichorous discharges; sensitiveness to touch or to coitus ; and a putridity, which is foreign to the other remedies mentioned.

STANNUM resembles Sepia in simple prolapsus uteri et vaginae, with "goneness," bearing down, melancholy. But its characteristic is falling of the uterus and vagina during hard stool. Dr. Hughes writes approvingly of its use in relieving the sensation of bearing down so common with womankind, and adds: "I have been quite astonished at its power over prolapsus. It seems to strengthen the uterine ligaments." (PHARMACODYNAMICS, 4th edition.)

NUXVOMICA agrees with Sepia in causing portal stasis, uterine congestion, haemorrhoids; urging to stool; backache, worse from motion; awakes at 3 A.M. But Nux produces a peculiar irritability of tissues, rendering the patient over-susceptible, while the functions are performed fitfully, spasmodically, and inharmoniously. Gastric symptoms predominate, and they are just those which result in a nervous person, from abuse of stimulants, highly seasoned food, etc. Thus, after a meal the clothing feels uncomfortable; retching predominates over actual vomiting. There are nausea, weakness, and a faint feeling after eating, as if produced by a strong purgative; but never the "goneness" of Sepia or Murex. There is frequent but ineffectual urging to stool, not inertia of the rectum. Menses are too early, though not very profuse, and are accompanied with more spasmodic pains and spasmodic movements in the abdomen than is Sepia, but with less steady bearing down and dragging. Nux has one symptom, common after lacerated perineum, viz.: internal swelling and burning of the vagina like a prolapsus.

ALOES acts on the liver, increases the bile, causes griping in the bowels, and diarrhoea. Its action on the bowels and uterus reminds us of Sepia, for it induces a determination of blood to these parts, with repletion of the veins and consequent irritation. But the relaxation, which is expressed in Sepia by dragging and "goneness," with weakness of the sphincters, is under Aloes declared as a more complete atony, a paresis.

It is expressed as heaviness, weight, with dragging down. This heaviness belongs to the pelvis, uterus, perineum, rectum, sacral region and the lower bowels. In fact, it is quite universal, even characterizing the headache; dull headache across above the forehead, with heaviness in the eyes and nausea—must make the eyes small with the pain—weight on the vertex. That the headaches belong to bowel and uterine affections, is proved by the fact that they alternate with symptoms of the latter (like PODOPHYLLUM).

Coupled with heaviness and congestion, is a weakness of the sphincters. The patient feels a lack of confidence in them ; fears lest stools will escape with flatus—faeces and urine will pass together—every time she passes urine, a feeling as if some thin stool would escape—sudden urging in the morning.

Aloes, then, is needed when with uterine congestion and prolapsus, there are heaviness in the abdomen and back, uncertain control of the rectum. The woman frequently suffers from loose bowels. Without any warning, she feels faint, with a sensation as if she was about to have diarrhoea. If the bowels move, there is more wind than substance, and she becomes prostrated and covered with a clammy Sweat.. If she has haemorrhoids, they protrude, and are relieved by cold applications.

PODOPHYLLUM suggests itself just here. It, too, acts on the liver, causes diarrhoea and prolapsus of the uterus and rectum ; hollow feeling in the epigastrium; pains in the ovaries (right) and down the anterior crural nerve. Burning in hypogastrium and sacral region, with retarded menses.

Its prolapsus uteri is, however, near akin to that of STANNUM, bearing down as if the genitals would come out during stool. In Stannum, however, it is recorded as occurring during hard stool; so Podophyllum causes the most relaxation in the pelvic region.

Podophyllum, it would seem, affects first the stomach and liver, and then uterine and rectal symptoms develop. We find it, therefore, most effective when its gastric symptoms concur with its uterine. While it resembles Sepia in causing bearing down in the hypogastric and sacral regions, relieved by lying down, aching in the ovaries, it differs in gastro-hepatic symptoms; fulness, weight, and dragging about the liver, soreness, better from rubbing. Diarrhoea only early in the morning or during the day; sometimes the passages are wholly fsecal, but are too frequent. Watery, gushing diarrhoea, from 3 A.M. into the forenoon. Prolapsus ani before stool. After stool weak, faint feeling in the abdomen, weak rectum and prolapsus of the same. This weakness resembles Aloes. It is the paresis of a violent purgative, not the general relaxation of Sepia.

PULSATILLANIGRICANS is very nearly related to Sepia. It cures scanty, late menses, bearing down, uterine cramps ; backache ; fainting; hemicrania, clavus. Suitable for women who are irresolute, yielding, lachrymose; or, silent, peevish, nothing pleases. Anxiety, which seems to come from the epigastrium or from the heart, with qualmishness.

Anxiety as if in a hot atmosphere, also at night, as from heat. Paint, must have air. Chilly, yet generally better in the open air ; chilly with the pains; anaemia; chlorosis.

The uterine pains of Pulsatilla are cutting, pressing with weighty feeling, converging toward the pudenda. The weighty sensation is compared to that of a stone, and is observed in the hypogastric and sacral regions. Constrictive, colicky, cramping pains predominate; actual bearing down is not so marked. Hence, we employ it so frequently in delayed menses and in labor. It acts fitfully; hence the uterine pains come by fits and starts, as does the menstrual flow; labor-pains are spasmodic, irregular, and finally stop with complete inertia. Thus there is want of power from the very beginning, shown in the fitful character of the contractions, and finally in their utter failure. Sepia causes more bearing down with the cramp. If indicated in labor, it is when an indurated and unyielding cervix retards the progress. And then there may be spasmodic contractions of the os and upward shooting pains. Here it favors GELSEMIUMANDCALCAREA; while Pulsatilla favors CAULOPHYLLUM and SECALE.

In temperament, Pulsatilla is tearful, mild; or peevish, whimsical, cross; Sepia is tearful, depressed, but easily irritated and excited; or indifferent.

As already intimated, Sepia is of use in a congested or indurated state of the cervix uteri, with soreness and burning. AURUM, AURUMMUR., AURUMMUR. NATRONAT. are similar. But though gold causes hyperaemia, it acts quite differently from Sepia. On studying its effects, one is impressed with the prominence of two sets of associated symptoms; namely, nervous excitation and vascular irritation. And yet the first no more represents innervation, than the second does true plethora. They indicate irritable weakness. Hepatic, renal and uterine congestion appear to arise secondarily to a cardiac irritation with hypersemia.

The prolonged action of gold develops a fever not unlike that of mercury, with profuse sweat, salivation, and copious urine. There is, too, a tendency to an overgrowth of fibrous tissue, whence result cirrhoses. The glands, at first stimulated, eventually become enlarged and indurated. The periosteum is diseased, and finally the bones become carious.

In keeping with these changes are its characteristic symptoms. Under its influence the emotions become greatly affected; easily enraged by trifling contradiction ; cheerfulness ; but the most persistent state is one of melancholy and disgust for life, with tendency to suicide. She imagines she has lost the affections of her friends; the fates are against her; she is no longer fit for this world, and she longs to die. She is seized with praecordial anxiety and tremulous fearfulness. Rush of blood to the chest when walking fast or for a long time, with bursting fulness. Bruised pain in the uterine region. Oversensitive to pain, nervous, tremulous, agitated. Uterus congested and prolapsed by its very weight. Sexual desire increased.

While then there are congestions, prolapsus, and melancholy, as in Sepia and Murex, the course of the symptoms is different, and especially are the mental symptoms different. In Aurum there is melancholy with depression, because of supposed loss of friendship ; in Sepia there is indifference to friends. Anxiety in the former is precordial, must move from place to place (as in ARSENIC ), a mere noise makes her anxious. Anxiety in the latter comes, it is true, with disturbed circulation, but it is not especially cardiac, and is accompanied with flushes of heat. Both produce weariness of life, with desire to die, even with suicidal tendency; Aurum, because she has lost the affections of her friends (Talcott); Sepia, from sheer loathing of life.

PLATINA favors on the one side gold, and on the other Sepia. All three have weariness of life. Platina, however, has with this a great dread of death, which the patient believes near at hand. As with Aurum the Platina patient feels as if she was alone, but she has a peculiar state of the mind, which finds a physical parallel in her power of vision. She is out of sorts with the world, for every thing seems too narrow. Things in her own home look strange on her return after a short absence. Persons are looked down upon as pitiful, insignificant, and very inferior to her. And similarly, OBJECTSABOUTHERLOOKTOBESMALLERTHANNATURAL.

Neither Aurum nor Sepia compares with Platina in the pronounced nymphomania and voluptuous irritation of the genitals. The menstrual flow in the latter is profuse and clotted instead of scanty.

Platina and Sepia have uterine cramp, but in the latter it is clutching, as if suddenly seized and then relaxed; in the former it is a decided cramping followed by numbness—a symptom which is universal in this remedy.

CARBOANIMALIS has proved itself equal, if not superior, to Sepia in indurations of the cervix, with burning tearing pain across the pubes. There are labor-like pains in the pelvis and sacrum; leucorrhoea stains yellow ; menses are followed by great weakness, she can hardly speak ; "goneness," not better from eating. Desire to be alone; she avoids all conversation; anxiety and orgasm. The carbons act on the veins, favor offensive flatus, offensive discharges and excoriations, which latter are superficial and irregular in outline. Inflammations are sluggish, but tend to suppuration or death of the parts, with burning pains, great weakness, collapse.

CARBOVEG. has caused bearing down in the rectum and vagina ; the os is unusually open; weight in the uterus and right ovary; MENSESHAVE A STRONGODOR; leucorrhoea excoriates; genitals are sore in places, smart, itch, burn, are aphthous. Anxiety with distended veins; a wretched, nervous feeling in the uterus, which culminates in the thighs ; nervous, fidgety. Mental depression before the menses.

The carbons, then, would come into use when induration or ulceration is present, with "venosity," offensive excoriating discharges, and with gastric disturbances, characterized by an accumulation and passage of offensive flatus.

Carbo veg. may cure varicose veins of the genitals, with blueness and burning—bluish tumors (CARBOANIMALIS being preferable if they are indurated)—ulcers, fistulae, vaginal discharges, when these are excoriating, thin, and ichorous ; while in Sepia they are less excoriating and are thicker. Burning across the sacrum, dragging from abdomen to small of the back. Burning pain deep in the pelvis, increasing and decreasing (Leadam).

CARBOANIMALIS causes violent pressing in the back, groins, and thighs during the menses, with unsuccessful urging to eructate. It is distinguished from Sepia by a throbbing headache, which follows the menses. It also has copper-colored acne on the face.

GRAPHITES is an impure carbon which contains traces of iron. It combines the offensive secretions, flatulency, and skin symptoms of the carbons, with anaemia.

According to Dunham the onset of the menses is accompanied with a variety of accessory symptoms, as with Sepia.

The remedy is not often quoted for prolapsus uteri, but it certainly is needed when there is a feeling as if the womb would press out the vagina; heavy load in the abdomen; lancinating-like electric shocks down the thighs (Leadam).

The leucorrhoea is profuse, coming in gushes, and is excoriating. The remedy affects the ovaries more decidedly than does Sepia; left ovary indurated, swollen, pains when the parts are touched.

Like Sepia it causes the nipples to inflame and crack. It is very useful to soften or remove cicatricial tissue in the mammae (like PHYTOLACCA).

But GRAPHITES is best adapted to women who are anaemic, though obese, who are constantly cold, constipated, and subject to a rough, herpetic condition of the skin. Eruptions are moist, and sweat is offensive as in Sepia, but only Graphites has the glueyness of the secretions well-marked. The skin grows hard, cracks and bleeds. There is less desquamation than in Sepia.

GRAPHITES, by virtue of its effect upon cicatricial tissue and indurations, ought to prove useful in softening the cervix when, as is often the case, a laceration has remained unhealed, acting as a source of irritation.

NATRUMCARBONICUM and other soda salts are complementary to Sepia.

The carbonate is needed when there is bearing down as if all would come out; melancholy, apprehensive ; oversensitive to music. Backache very like Sepia; heaviness, worse sitting, better moving, bruised pain over the back at night, tension, boring from tip of left scapula through. Skin dry, rough.

Clinically, it has served when the cervix is enlarged, with ill-shaped os. Dr. Betts has succeeded with it in congenital defective growth of the anterior vaginal wall and this ill-shaped os.

NATRUMMURIATICUM is suited to anaemic women, with thin worn face and general emaciation. They are melancholic, easily angered, suffer from nervous weakness, with palpitation, trembling, anxiety, and predominant chilliness ; inclined to sweat; sweat in the axillae with chilliness over the back; prolapsus uteri; cramps, scanty menses, urine with red sediment; painful coitus. It therefore resembles both Pulsatilla and Sepia. But consolation aggravates (Pulsatilla is easily pacified, seeks consolation) ; headaches congestive, pseudo-plethoric, with bursting pains, worse from the least motion, even of the eyeballs; mucous membranes smart as with Sepia, but there is an abnormal dryness; thus, tongue feels dry, eyelids are dry, rectum dry, smarts, etc. With this there is a tendency to erosions, with smarting burning ; thus the tongue is sore and ulcerated; gums sore and bleed. Skin unnaturally dry. The prolapsus uteri is worse in the morning, must sit down to prevent it, with backache, which is relieved by lying on the back. Tension in the hypogastric and inguinal regions as if the skin was tight (APIS). Leucorrhoea greenish, with smarting and feeling of dryness. Cutting in the urethra, which is most marked after urination. Menses scanty, or scanty a day or two and then copious.

NATRUMHYPOCHLOROSUM varies the case. According to the prover, Dr. K. T. Cooper, it is useful in debilitated persons, of lax fibre and rather sluggish, mentally and bodily. This debility is accompanied with emaciation, nervous exhaustion and other evidences of deep-seated changes in the organism. There are vertigo to falling, with aching across the forehead and uterine bearing down; swimming feeling as if the top of the cranium were about to float off. Pains across the forehead and eyes or on vertex, with uterine symptoms. Brain feels paralyzed, also the limbs, fingers numb; fainting spells. Tongue large, takes print of teeth; flatulency, costive, bloated after meals, flatulent asthma—all indicating abdominal plethora.

These symptoms are met with in connection with uterine diseases. Menses clotted, black ; sleepiness, dark circles around the eyes. Bearing down in the uterus, which may be congested, enlarged and sensitive; constant oozing of blood, worse from any exertion. Womb feels as if it opened and shut; thus not precisely the clutching and relaxing of Sepia. Feels as if the womb was pushed up when she sits down (a symptom of Ferrum iod. also). Swelling low down in the abdomen, going up to the chest, causing dyspnoea, worse after eating. A weight seems to fall from across the pit of the chest to the abdomen, with aching on the top of the head. Swelling in the left ovarian region at time of menses. It seemed to cause the prolapsed uterus to rise into its place, reminding one of the experiments of Dr. Jackson with Sepia. Pruritus. Weak feeling about the chest. Easily overpowered with heat. This latter is also in Sepia as well as NATRUMMUR. and NATRUMCARB.

ACTEARACEMOSA is invaluable in the treatment of women. It is especially adapted to those who are predisposed to muscular rheumatism and myalgia. It causes hypersemia of the brain and cord, and even inflammation in the cervical and dorsal spine. Hence comes its occipital pains, lightning-like pains, delirium, etc. (see below). It here resembles ABSINTHE, ABROTANUM, GELSEMIUM ; the last of which remedies, however, has more drowsiness and muscular paresis with less excitement.

Sepia, too, causes fulness of the spinal vessels, but less marked than Actea, more passive, more torpid. Sensory nerves, in Actea, are excited, while, at the same time, like the motor nerves and the muscles, they are weak. The heart acts feebly and nervously, the pulse is either very quick and feeble or too slow and intermitting. With this there is scanty urine, depositing a red or yellow sediment. There is a general feeling of uneasiness, restlessness and fidgets ; or tremors, nervous chills. The muscles feel sore, bruised, stiff; severe myalgic pains, with numb feeling. Pains violent, dart like lightning. Phillips recommends it even for anasarca with the above condition of heart and urinary secretion, "even when Digitalis failed."

Actea, then, is preeminently a remedy for "irritable weakness." As with Sepia, there are nervousness, restlessness, melancholy, scanty menses with bearing down, etc. But Actea produces a more decided nervous excitement, amounting to delirium, wjth hallucinations of rats, etc.; it develops an overwhelming apprehensiveness, with no apparent cause, but which cannot be overcome, reducing the patient to despair. In her excited state she feels as if the top of her head was flying off and she would go crazy. She becomes suspicious, irritable and is dizzy as if intoxicated. All these symptoms form a part of the general nervous state, which depends upon an irritated condition of the uterus and ovaries; or is, at least, perpetuated thereby. And the disturbed state of the uterus seems to be based on a rheumatic diathesis. She suffers more from neuralgia than the Sepia patient; dull aching from occiput to vertex; aching soreness in the eyeballs, sharp pains thence to the vertex, with red, congested eyes—all associated with flexed or irritable uterus. Very important, too, are neuralgic pains in and about the latter organ; uterus sensitive to touch, pains shoot across from side to side; bearing down, with tightness around the hips, menses scanty, pain continues after flow begins. The epigastric faintness is not quite the "goneness" of Sepia. It is accompanied with nervousness, tremors, waves spreading thence all over, feeling as if frightened. Sepia may be needed in asthenopia, reflex from the uterus; Actea rather in hyper-aesthesia of the retina or in ciliary neuralgia, reflex from the uterus. Both are very useful at the climacteric; Sepia for the flushes of heat; Actea, according to Hughes, for irritability, pain at the vertex, and sinking at the stomach.

But these effects ought not to be confounded with those of SEPIA. For the drug is an intense poison, acting on the muscles and heart, etc. The gastric sinking is connected with weakened heart, the beats of which become diminished in number and force, with consequent coldness, sinking, vertigo, numbness, and tremors. The remedy, then, suits the debilitated when the heart fails. It is closely allied to KALICARB. in weak heart.

CALCAREAOSTREARUM causes a pressure in the lower abdomen on physical exertion. Bearing down, worse standing; aching in the thighs. Sore pain, tension, worse holding oneself erect or bending backwards. Stinging in the cervix, stitches. But the menses are profuse and too early, and the general symptoms are, as is well known, very different from those of Sepia.

CALCAREAPHOSPHORICA (like PHOSPHORUS) produces a weak sinking feeling in the hypogastrium; empty sinking sensation at the epigastrium. Prolapsus is worse during stool or micturition, with sense of weakness and distress. Aching in the uterus. Cutting through to sacrum. Cream-like leucorrhoea. Burning in the vagina, with pain on both sides of the bladder and uterus; burning like fire up into the chest. Flushes of heat, anxiety, faintness, debility; she sweats easily.

But the menses are profuse and there is sexual excitement. She is weak and emaciated, consumptive; suffers from partial profuse sweats; but they are not offensive as in Sepia. Every exposure increases her rheumatic pains and, with these, her distress at the uterus.

Among the remaining remedies I may briefly refer to the following:

MITCHELLA, cervix engorged, dark red, swollen. This is associated with an irritation at the neck of the bladder, with urging to urinate. There are, however, no general resemblances to Sepia. The remedy is rather to be classed with Eupatorium purpureum, vesical irritability in women (Hughes)—HYDROCOTYLE, irritation of the neck of the bladder; cervix uteri red, with heat and itching of the vagina (confirmed by Dr. Mitchell)—VESPA, ulcer around the os; APIS, dysuria.

Sepia ought not to be confounded with SECALE C. and USTILAGO; for although the three cause bearing down, congestion, aching distress, and prolapsus uteri, the conditions are quite different. The last two act on the muscular coat of the bloodvessels and involuntary muscular fibres in general. Secondarily, from undue relaxation, they favor tumefactions, passive hemorrhages. Their "bearing down" is prolonged, marked (like CAULOPHYLLUM). USTILAGO has relieved uterine haemorrhage; also vomiting of blood in a lady with uterine disease; passive flow of blood; the examining finger detects a soft, patulous cesvix, and is stained with blood (Woodbury).

VIBURNUMOPULUS has caused and cured pains, coming as in Sepia, around the pelvis to the uterine region, also "goneness," empty feeling at the stomach; bearing down; "nervousness." But the bearing down is much more violent, and culminates in the uterus in intense cramp; thus favoring CAULOPHYLLUM, ACTEARAE., SECALE, etc., rather than Sepia.

INULA and HEDEOMA have been proved, but clinical experience is wanting. Like Sepia, they cause uterine pains and bearing down; the first, dragging in the genitals, backache, urging to stool and to micturition ; the second, bearing down with great weakness in the legs.

Sepia, in a few instances, has relieved choreic-like symptoms ; sudden jerking of the head backwards and forwards; twisting in the stomach and then a rising to the throat. Among similar remedies we should not forget to include ZIZIA. It causes an increase of blood in the uterus, backache, smarting, burning in the back ; spasmodic movements of the face and limbs. The mind is at first exhilarated, then depressed, and finally a state of indifference obtains. The most marked characteristic, however, is restless, choreic movements, worse during sleep.

When prolapsus uteri is a symptom of general defective nutrition, with little or no local congestion, Sepia yields to ALETRIS, CAULOPHYLLUM, ABIESCANADENSIS, LACDEFLORATUM, CALCAREAPHOS., NATRUMMUR., HELONIAS, NATR. HYPOCHLOR.

In threatened abortion Sepia is indicated not so much by the pains as by the evidence of disturbed circulation. This, together with irritable nerves and laxness of tissue, makes up the cause of the impending catastrophe. It will be noticed that there are, or there have been, fulness and pressure of blood to the head and chest, feeling of heaviness in the abdomen, piles; flushes of heat, with faintness and momentary attacks of blindness—observed especially when the patient was in a warm or close room, kneeling as in church, when steadily using the eyes, etc. A common attendant, clearly expressive of the nature of the Sepia case, is the excellent keynote of Dr. H. N. Guernsey; sense of weight in the anus like a heavy ball.

This last symptom is unique, differing materially from the urging of Nux and Sulphur, the pressure of Lilium, and the fulness and weight of Aloes. The latter has also sensation of a plug wedged in between symphysis pubis and os coccygis.